目的将基准剂量法应用于燃煤氟暴露人群,探讨燃煤氟污染致暴露人群骨代谢损伤的生物暴露限值,为燃煤氟致骨损伤的防治提供参考依据。方法以贵州省燃煤污染型氟中毒病区295例氟暴露者为氟暴露组,非氟污染区85例居民为对照组。在知情同意原则下,采集调查对象尿液和血液样本,采用氟离子电极法测定尿氟含量,以酶联免疫吸附试验测定血清骨钙素含量,以微量酶标法检测碱性磷酸酶活力。分析尿氟与骨代谢损伤指标之间关系,并应用BMDS 2.6.0.1软件计算基准剂量(BMD)、95%的可信限下限值(BMDL)。结果按尿氟分组后,随着尿氟浓度的升高,血清骨钙素和碱性磷酸酶水平逐渐升高,存在剂量-效应关系,差异有统计学意义(P<0.05)。骨钙素与碱性磷酸酶的尿氟BMD与BMDL分别为0.581、0.412 mg/g Cr和2.374、1.362 mg/g Cr。结论建议燃煤氟暴露引起人群骨代谢损伤的尿氟生物暴露限值为0.412 mg/g Cr;骨钙素可作为氟暴露早期效应指标和氟接触高危人群的敏感筛选指标。 OBJECTIVE: To apply the standard dose method to the fluorosis exposed to coal-fired persons to explore the bio-exposure limits of bone metabolism damage caused by fluorine-exposed coal-fired people, and to provide a reference for the prevention and treatment of bone fluorosis induced by coal combustion. Methods A total of 295 cases of fluoride exposure in Guizhou Province with coal-burning fluorosis poisoning were exposed to fluoride, and 85 residents in non-fluoride-contaminated area were used as the control group. Under the principle of informed consent, urine and blood samples were collected. Urinary fluoride content was measured by fluoride ion electrode method. Serum osteocalcin levels were measured by enzyme-linked immunosorbent assay. Alkaline phosphatase activity was measured by microplate reader. The relationship between urinary fluoride and bone damage index was analyzed. BMD was calculated using BMDS 2.6.0.1 software, and the 95% confidence interval (BMDL) was calculated. Results According to the urinary fluoride group, with the increase of urinary fluoride concentration, serum osteocalcin and alkaline phosphatase levels gradually increased, there is a dose-response relationship, the difference was statistically significant (P <0.05). The urinary fluoride BMD and BMDL of osteocalcin and alkaline phosphatase were 0.581, 0.412 mg / g Cr and 2.374, 1.322 mg / g Cr, respectively. Conclusion It is suggested that the limit of bio-exposure to urinary fluoride should be 0.412 mg / g Cr. The osteocalcin may be used as a sensitive indicator of early exposure to fluoride exposure and high risk of fluoride exposure.